title: Vascular access morbidity and mortality: trends of the last decade.
abstract: During the past decade, clear trends in the types of incident and prevalent hemodialysis vascular access can be observed. There has been a steady increase and recent stabilizaton of patients initiating hemodialysis with a central venous catheter, representing approximately 80% of all incident accesses. There has also been a steady increase in prevalent fistula use, currently greater than 50% within 4 months of hemodialysis initiation. Patient and vascular access related morbidity and mortality are reflected in the type of vascular access used at initiation and for long-term maintenance dialysis. There is a three- to fourfold increase in risk of infectious complications in patients initiating dialysis with a catheter compared with either a fistula or graft and a sevenfold higher risk when the catheter is used as a prevalent access. Procedure rates have increased two- to threefold for all types of access. There is a significant increased risk of mortality associated with catheter use, especially within the first year of dialysis initiation.
authors.affiliation: Department of Medicine, Division of Nephrology, Toronto General Hospital and The University of Toronto, Toronto, Ontario, Canada. charmaine.lok@uhn.ca
authors.forename: Charmaine E
authors.initials: CE
authors.lastname: Lok
authors.forename: Robert
authors.initials: R
authors.lastname: Foley
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000191:economics / Q000401:mortality / Q000639:trends*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000191:economics / Q000401:mortality / Q000639:trends*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000191:economics / Q000401:mortality / Q000639:trends*; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D007674:Kidney Diseases / Q000191:economics / Q000401:mortality / Q000628:therapy*; D006435:Renal Dialysis / Q000009:adverse effects / Q000191:economics / Q000401:mortality / Q000639:trends*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome